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Infertility problem, no children and 4 miscarriages. Transvaginal pelvic scan showed complex cyst on right ovary. What could this be?

Mar 2016
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I am a 49 year old female. LMP was in November of 2011, and had been very irregular for the previous 2 years. Infertility problem, no children, 4 miscarriages. In mid-June 2013, I started to experience what felt like period symptoms coming on (breast soreness, increased libido). About a week later, I experienced a very small amount of what I thought was post-menopausal bleeding (no more than a teaspoon), along with an odd-colored greenish/yellowish discharge. I made appointment with OB/GYN, who did the normal workup, i.e., pelvic U/S, endometrial biopsy, bloodwork. She referred me to an imaging center because she saw a cyst on my right ovary. She told me she thought I may have ovulated (which I guess would indicate that I am perimenopausal), and that this may be the cause of the small amount of bleeding. (Endometrial biopsy was negative, bloodwork (for Thyroid)normal). Two days later, I had a transvaginal pelvic U/S which showed a complex cyst on my right ovary, the findings of which are attached. This is pretty much word-for-word. The Radiologist did not mention anything about vascularity, nodules, septations, etc., on the complex cyst in his report. My concern, obviously, is ovarian cancer; however, neither the Radiologist nor the OB/GYN seem too concerned. Can someone shed some light on hat this complex cyst may be, and what I can expect going forward?
Thank you.
Posted Thu, 8 Aug 2013 in Women's Health
Answered by Dr. S Patra 1 hour later

Thanks for writing to us on Healthcare Magic.

The very first thing, your history and presenting clinical features are more consistent with peri-menopausal symptoms. These are quite natural phenomena in association with hormonal ups and downs in your age.

Second thing, I have reviewed your attached ultrasound scan report. It reveals a very small (1.6 cm) complex ovarian cyst in the right side. It is named complex due to presence of both solid and fluid material. It occurs less frequently and mostly associated with irregular cycle. However, most of them are benign or harmless.

There are 3 types of complex ovarian cyst- dermoid cyst, cystadenoma and endometrioma. Here, you can undergo serum CA-125, Hormone assay (LH, FSH), one MRI scan to know the nature of the cyst. Though, histopathological examination of the cyst is more convenient for typing. Your consulting gynecologist can help you regarding this.

Most complex ovarian cyst disappears within 2-3 months. Therefore, wait & watch with follow-up ultrasound scan is recommended in most of the cases. As the cyst is very small, no surgical treatment is required.

Last thing, I can suggest that you can opt for surrogate pregnancy if healthy ovum is obtained. Husband semen analysis should be normal. Alternatively, donor sperm and ovum may be used in extreme case. It is the best option in your age with H/O recurrent miscarriage. You can consult with your doctor regarding this for proper guidance.

Hope, above information is quite helpful for your understanding. If you need any clarification further, you can freely ask me.

Wish your good health and take care yourself.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: Infertility problem, no children and 4 miscarriages. Transvaginal pelvic scan showed complex cyst on right ovary. What could this be? 1 hour later
Thank you for your reply. Based on what I have described, and I know this may be difficult to answer, how concerned should I be that this cyst may be malignant?

Thank you.
Answered by Dr. S Patra 12 minutes later

Thanks for follow up query.

Basically, complex cysts are benign and they will disappear in most of the cases. The chance of malignant potential is high among postmenopausal women with near about 0.3%. It is common with dermoid cyst and endometrioma. Therefore, follow up ultrasound scan and relevant blood tests are recommended for better prognosis.

Hope, I have answered your query. If you do not have any other query, you can close the discussion.

Good luck. Be well & stay healthy.

Dr Soumen
Above answer was peer-reviewed by
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